Advertisement

Annals of Surgical Oncology

, Volume 20, Issue 12, pp 3754–3760 | Cite as

Resection of Hepatocellular Carcinoma with Macroscopic Vascular Invasion

  • Sasan Roayaie
  • Ghalib Jibara
  • Bachir Taouli
  • Myron Schwartz
Hepatobiliary Tumors

Abstract

Background

Survival for Child’s A patients with hepatocellular cancer (HCC) and macroscopic vascular invasion (MVI) has been reported as approximately 8.1 months with sorafenib. The role of surgery for these patients remains controversial.

Methods

The records of all patients undergoing resection of HCC at a single center were reviewed. Only patients with pathologically proven MVI were included. Inclusion criteria for resection required Child’s A liver disease, no clinical portal hypertension (after 2002), and no extrahepatic disease. The superior mesenteric vein and portal vein branch to the remaining lobe had to be patent.

Results

We identified 165 patients with MVI treated with hepatic resection between June 1992 and March 2010. Median follow-up was 11.9 months with 127 deaths, including 12 (7.3 %) perioperative mortalities. Median and 5-year survivals were 13.1 months and 14 %. Multivariate analysis found α-fetoprotein (AFP) >30 ng/ml (hazard ratio 2.07), tumor size >7 cm (hazard ratio 1.59), and extent of vascular invasion (hazard ratio 1.74) to be independently associated with survival. Those with invasion of hepatic veins or vena cava had a median survival of only 4.7 months.

Conclusions

The results for resection of HCC with MVI remain somewhat disappointing but are better than what is reported with medical therapy in similar patients. Tumor size, AFP, and extent of vascular invasion can help select those that will benefit most from hepatic resection. Resection of patients with hepatic vein or vena cava involvement may not be justified, given such poor results.

Keywords

Sorafenib Tace Hepatic Vein Hepatic Resection Main Portal Vein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdel C, Sala M, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology. 1999;29:62–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Villa E, Moles A, Ferretti I, Buttafoco P, Grottola A, Del Buono M, et al. Natural history of inoperable hepatocellular carcinoma: estrogen receptors’ status in the tumor is the strongest prognostic factor for survival. Hepatology. 2000;32:233–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Llovet JM, Fuster J, Bruix J; Barcelona Clinic Liver Cancer Group. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl. 2004;10(2 Suppl 1):S115–20.CrossRefGoogle Scholar
  4. 4.
    Bruix J, Raoul JL, Sherman M, Mazzaferro V, Bolondi L, Craxi A, et al. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: subanalyses of a phase III trial. J Hepatol. 2012;57:821–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Kim KM, Kim JH, Park IS, Ko GY, Yoon HK, Sung KB, et al. Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion. J Gastroenterol Hepatol. 2009;24:806–14.PubMedCrossRefGoogle Scholar
  6. 6.
    Chung JW, Park JH, Han JK, Choi BI, Han MC. Hepatocellular carcinoma and portal vein invasion: results of treatment with transcatheter oily chemoembolization. AJR Am J Roentgenol. 1995;165:315–21.PubMedCrossRefGoogle Scholar
  7. 7.
    Georgiades CS, Hong K, D’Angelo M, Geschwind JF. Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis. J Vasc Interv Radiol. 2005;16:1653–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Pawlik TM, Poon RT, Abdalla EK, Ikai I, Nagorney DM, Belghiti J, et al. Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: results of a multicenter study. Surgery. 2005;137:403–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Inoue Y, Hasegawa K, Ishizawa T, Aoki T, Sano K, Beck Y, et al. Is there any difference in survival according to the portal tumor thrombectomy method in patients with hepatocellular carcinoma? Surgery. 2009;145:9–19.PubMedCrossRefGoogle Scholar
  10. 10.
    Sangro B, Carpanese L, Cianni R, Golfieri R, Gasparini D, Ezziddin S, et al. Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across barcelona clinic liver cancer stages: a European evaluation. Hepatology. 2011;54:868–78.PubMedCrossRefGoogle Scholar
  11. 11.
    Xu X, Zheng SS, Liang TB, Wang WL, Jin J, Shen Y, et al. Orthotopic liver transplantation for patients with hepatocellular carcinoma complicated by portal vein tumor thrombi. Hepatobiliary Pancreat Dis Int. 2004;3:341–4.PubMedGoogle Scholar
  12. 12.
    Minagawa M, Makuuchi M, Takayama T, Ohtomo K. Selection criteria for hepatectomy in patients with hepatocellular carcinoma and portal vein tumor thrombus. Ann Surg. 2001;233:379–84.PubMedCrossRefGoogle Scholar
  13. 13.
    Fukuda S, Okuda K, Imamura M, Imamura I, Eriguchi N, Aoyagi S. Surgical resection combined with chemotherapy for advanced hepatocellular carcinoma with tumor thrombus: report of 19 cases. Surgery. 2002;131:300–10.PubMedCrossRefGoogle Scholar
  14. 14.
    Llovet JM, Schwartz M, Mazzaferro V. Resection and liver transplantation for hepatocellular carcinoma. Semin Liver Dis. 2005;25:181–200.PubMedCrossRefGoogle Scholar
  15. 15.
    Wu CC, Hsieh SR, Chen JT, Ho WL, Lin MC, Yeh DC, et al. An appraisal of liver and portal vein resection for hepatocellular carcinoma with tumor thrombi extending to portal bifurcation. Arch Surg. 2000;135:1273–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Ohkubo T, Yamamoto J, Sugawara Y, Shimada K, Yamasaki S, Makuuchi M, et al. Surgical results for hepatocellular carcinoma with macroscopic portal vein tumor thrombosis. J Am Coll Surg. 2000;191:657–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Poon RT, Fan ST, Ng IO, Wong J. Prognosis after hepatic resection for stage IVA hepatocellular carcinoma: a need for reclassification. Ann Surg. 2003;237:376–83.PubMedGoogle Scholar
  18. 18.
    Fan J, Wu ZQ, Zhou J, Qiu SJ, Shi YH, Chen RX, et al. Hepatocellular carcinoma associated with tumor thrombosis in the portal vein: the effects of different treatments. Hepatobiliary Pancreat Dis Int. 2003;2:513–9.PubMedGoogle Scholar
  19. 19.
    Fan J, Zhou J, Wu ZQ, Qiu SJ, Wang XY, Shi YH, et al. Efficacy of different treatment strategies for hepatocellular carcinoma with portal vein tumor thrombosis. World J Gastroenterol. 2005;11:1215–9.PubMedGoogle Scholar
  20. 20.
    Le Treut YP, Hardwigsen J, Ananian P, Saisse J, Gregoire E, Richa H, et al. Resection of hepatocellular carcinoma with tumor thrombus in the major vasculature. A European case-control series. J Gastrointest Surg. 2006;10:855–62.PubMedCrossRefGoogle Scholar
  21. 21.
    Chen XP, Qiu FZ, Wu ZD, Zhang ZW, Huang ZY, Chen YF, et al. Effects of location and extension of portal vein tumor thrombus on long-term outcomes of surgical treatment for hepatocellular carcinoma. Ann Surg Oncol. 2006;13:940–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Zhou J, Tang ZY, Wu ZQ, Zhou XD, Ma ZC, Tan CJ, et al. Factors influencing survival in hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis after surgery, with special reference to time dependency: a single-center experience of 381 cases. Hepatogastroenterology. 2006;53:275–80.PubMedGoogle Scholar
  23. 23.
    Ikai I, Hatano E, Hasegawa S, Fujii H, Taura K, Uyama N, et al. Prognostic index for patients with hepatocellular carcinoma combined with tumor thrombosis in the major portal vein. J Am Coll Surg. 2006;202:431–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Liang LJ, Hu WJ, Yin XY, Zhou Q, Peng BG, Li DM, et al. Adjuvant intraportal venous chemotherapy for patients with hepatocellular carcinoma and portal vein tumor thrombi following hepatectomy plus portal thrombectomy. World J Surg. 2008;32:627–31.PubMedCrossRefGoogle Scholar
  25. 25.
    Shimada K, Sakamoto Y, Esaki M, Kosuge T. Role of a hepatectomy for the treatment of large hepatocellular carcinomas measuring 10 cm or larger in diameter. Langenbecks Arch Surg. 2008;393:521–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Ban D, Shimada K, Yamamoto Y, Nara S, Esaki M, Sakamoto Y, et al. Efficacy of a hepatectomy and a tumor thrombectomy for hepatocellular carcinoma with tumor thrombus extending to the main portal vein. J Gastrointest Surg. 2009;13:1921–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Kondo K, Chijiiwa K, Kai M, Otani K, Nagaike K, Ohuchida J, et al. Surgical strategy for hepatocellular carcinoma patients with portal vein tumor thrombus based on prognostic factors. J Gastrointest Surg. 2009;13:1078–83.PubMedCrossRefGoogle Scholar
  28. 28.
    Ruzzenente A, Capra F, Pachera S, Iacono C, Piccirillo G, Lunardi M, et al. Is liver resection justified in advanced hepatocellular carcinoma? results of an observational study in 464 patients. J Gastrointest Surg. 2009;13:1313–20.PubMedCrossRefGoogle Scholar
  29. 29.
    Shi J, Lai EC, Li N, Guo WX, Xue J, Lau WY, et al. Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus. Ann Surg Oncol. 2010;17:2073–80.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Sasan Roayaie
    • 1
  • Ghalib Jibara
    • 1
  • Bachir Taouli
    • 2
  • Myron Schwartz
    • 1
  1. 1.Mount Sinai Liver Cancer ProgramMount Sinai Medical CenterNew YorkUSA
  2. 2.Department of RadiologyMount Sinai Medical CenterNew YorkUSA

Personalised recommendations